renal sympathetic denervation for patients with chronic heart failure

Conditions: Chronic Heart Failure

Summary: to study whether renal sympathetic denervation(rsd) rsd can slow the progression of chf and reduce the rate of all-cause mortality effectively and securely.

chronic heart failure(chf) as the final stage of various heart diseases is a global and growing public health problem, and its morbidity increases with age. at present, the main therapies for chf contain drug therapy (including angiotensin-converting enzyme inhibitors, aldosterone antagonist, beta-receptor blockers, diuretic, digoxin etc ) , crt-d(cardiac resynchronization therapy )/icd(implantable cardioverter-defibrillator), biological treatment, ultrafiltration dialysis, heart transplantation and so on. optimize drug therapy is the foundation of chf, but hypotension and bradycardia limit its indications. esc(european society of cardiology)/aha(american heart association) guidelines recommended crt-p/d and icd for drug resistant chf, but the financial burden limit the use of them and some patients have no response to them. donors and high costs are considered as two problems which limit heart transplantation appeal. above all, we are always searching for a new treatment strategy for patients with chronic heart failure. chronic over-activation of sympathetic nervous system is a major component of heart failure and involves efferent and afferent pathways between brain and many organs. recently, some studies in animals and humans suggest that activation of both efferent and afferent renal nerves play a crucial role in the pathogenesis and progression of chf. activation of renal nerves in chf may cause a reflex increase in sympathetic tone that contributes to elevated peripheral vascular resistance and vascular remodeling as well as left ventricular remodeling and dysfunction. recently, many clinical trials have corroborated that catheter-based renal sympathetic denervation (rsd) significantly decreased sympathetic-nerve activity (msna) in muscle and whole-body, with a decrease in renal and whole-body norepinephrine spillover. simultaneously, many clinical researches have also verified that rsd can safely be used to control hypertension, reduce left ventricular hypertrophy, improve glucose tolerance impaired ,decrease proteinuria and sleep apnea severity, which are all recognized as independent risk factors for the development and progression of chf. therefore, this randomized parallel control clinical trial was designed to demonstrate whether rsd can slow the progression of chf and reduce the rate of all-cause mortality effectively and securely.

Eligibility criteria:
inclusion criteria: 1. individual is ≥18 and ≤ 75 years of age 2. individual has a history of heart failure more than half a year 3. individual's cardiac function is betweenⅱ-ⅳlevel(nyha) 4. ejection fraction ≦ 35% 5. renal artery cta (computed tomographic arteriography)inspection renal artery length ≧ 2 cm, diameter ≧ 4 mm, no single double renal artery, renal artery start without distortion/tumor sample expansion,ect 6. individual agrees to have all study procedures performed and is competent and willing to provide written,informed consent to participate in this clinical study exclusion criteria: 1. individual has hemodynamically significant valvular heart disease for which reduction of blood pressure would be considered hazardous. 2. individual has experienced renal artery stenosis,or a history of prior renal artery intervention including balloon angioplasty or stenting. 3. individual has an estimated glomerular filtration rate (egfr) of \< 45ml/min/1.73m2, using the mdrd(modification of diet in renal disease) calculation. 4. individual has acute heart failure. 5. individual has experienced a cerebrovascular accident within 3 months of the screening visit, or has widespread atherosclerosis, with documented intravascular thrombosis or unstable plaques. 6. individual has experienced sick sinus syndrome. 7. individual has any serious medical condition, which in the opinion of the investigator, may adversely affect the safety and/or effectiveness of the participant or the study (i.e., patients with clinically significant peripheral vascular disease, abdominal aortic aneurysm, bleeding disorders such as thrombocytopenia, hemophilia, or significant anemia, or arrhythmias such as atrial fibrillation). 8. individual is pregnant, nursing or planning to be pregnant. \[female participants of childbearing potential must have a negative serum or urine human chorionic gonadotropin (hcg) pregnancy test prior to treatment.\] 9. individual has a known, unresolved history of drug use or alcohol dependency, lacks the ability to comprehend or follow instructions, or would be unlikely or unable to comply with study follow-up requirements. 10. individual is currently enrolled in another investigational drug or device trial.

Keywords: chronic heart failure renal sympathetic denervation